Martha DeLeon
Kissimmee,FL
Summary
Resourceful Customer Service Representative known for maintaining high productivity and efficiently completing tasks. Skilled in conflict resolution, time management, and communication, ensuring smooth operational flow and customer satisfaction. Excel in active listening, empathy, and adaptability, leveraging these soft skills to navigate customer interactions successfully and foster positive outcomes.
Overview
17
17
years of professional experience
1
1
Certification
Work History
CSR - Customer Service Representative
Centene Corporation
Orlando, US
10.2018 - Current
- Assist members and/or providers with health plan inquiries within established time frames utilizing available materials and resources
- Research and provide information regarding member's eligibility, benefits, referrals, and authorizations by utilizing various systems/tools
- Research and identify any processing inaccuracies in claims, billing, benefit and eligibility, authorizations and route to the appropriate site operations team
- Maintain performance and quality standards based on established metric system
- Assist and participate in special projects such as POM Campaign, Floor Support, and team engagement
Health Insurance License Specialist
DialAmerica
Orlando, US
02.2017 - 11.2018
- Health Insurance License Specialist for Healthfirst Medicare Advantage Plans
- Verifying and completing enrollment application for members and prospects
- Knowledgeable with Epaces system for NY Medicaid and Marx system for Medicare
- Research and provide information regarding member's eligibility, benefits, referrals, and authorizations by utilizing various systems/tools
- Manage escalated member's concerns and follow the member experience from beginning to resolution
Quality Control Operator 3 Inspector
Abbott Laboratories
Barceloneta, US
08.2007 - 12.2016
- Inspected finished products for quality and adherence to customer specification
- Adhere to all applicable regulations, policies and procedures for health, safety and environmental compliance
- Quality inspection for the safety of the product and their patient
- Blue Print, GMP, ISO and FDA Regulation
- Production and Manufacturing
- Microsoft Word, Excel, Power Point, Mechanical Knowledge, Codes and Standards
Education
Certification in Computer Science -
Globelle Technical Ins
Vega Baja, PR07-2002
High School Diploma -
Lino Padron Rivera
Vega Baja, PR05-1999
Skills
- Strategic Thinking & Foresight
- Medical & Behavioral Health
- Managing (People Leader)
- Excellent Communication Skills
- Mentoring
- Analytical skills
- Complex problem solving & decision making
- Organizational Infrastructure
- Cross functional collaboration
- 10 years Customer Service
- Microsoft
- Excel
- Power Point
- Grievance & Appeals
Certification
- Computer Science, 05/01/02, Present
- Health License 240, 07/01/17, Present
Timeline
CSR - Customer Service Representative
Centene Corporation
10.2018 - Current
Health Insurance License Specialist
DialAmerica
02.2017 - 11.2018
Quality Control Operator 3 Inspector
Abbott Laboratories
08.2007 - 12.2016
Certification in Computer Science -
Globelle Technical Ins
High School Diploma -
Lino Padron Rivera